thank you __PUNCT__
thank you all veri much __PUNCT__
thank you nanci for your introduct and for your leadership of thi great medic center __PUNCT__ and to frank mcdougal who ha also help veri much in put thi event togeth __PUNCT__
i also want to thank dr __PUNCT__ susan lynch for be here __PUNCT__
some of you know that dr __PUNCT__ lynch did her resid at dartmouth __PUNCT__ hitchcock and she a pediatrician who work as a pediatr lipid specialist at the cholesterol treatment center at concord hospit in concord __PUNCT__
it would be interest to know just as histor fact when the first pediatr lipid specialist wa certifi becaus on think about cholesterol as a problem of us __PUNCT__ the adult world __PUNCT__
and now we know __PUNCT__ as dr __PUNCT__ lynch too well know __PUNCT__ with her advocaci on behalf of physic activ and try to stem the tide of obes among our children __PUNCT__ how signific thi is and i just absolut delight that she could be here todai __PUNCT__
it also a pleasur be back here __PUNCT__
i just had the opportun to sai hello to some of the physician and nurs and staff member who run thi great center __PUNCT__
and a number of them remind me that i wa here in __NUM__ i actual met some of them befor thi occas and i am thrill to be back becaus i cannot imagin a more fit place to talk about improv healthcar qualiti in america than at thi institut which ha help to set the standard for excel for more than __NUM__ year __PUNCT__
as i travel across new hampshir __PUNCT__ and certainli around our countri __PUNCT__ i talk with peopl from all walk of life __PUNCT__ it is realli on of the great privileg of be in public life __PUNCT__ i see the speaker here __PUNCT__ and other who ar involv in the dai __PUNCT__ to __PUNCT__ dai life of new hampshir __PUNCT__
you get to meet peopl you would have never otherwis met __PUNCT__ you ar invit into their live __PUNCT__ somewhat similar to what you do here __PUNCT__ as you take care of them in veri signific point of their life journei __PUNCT__
well in the polit arena we also have that privileg and no matter where i go __PUNCT__ or with whom i talk __PUNCT__ whether it a ceo or a small busi owner or a doctor or a nurs or patient or a hospit administr __PUNCT__ everyon tell me the same thing __PUNCT__ our health care system isn't work and what can we do about it __PUNCT__ the cost ar too high __PUNCT__ the coverag too thin __PUNCT__ or in some case non __PUNCT__ exist __PUNCT__ the care not what it should be __PUNCT__
now i have work on health care __PUNCT__ like nanci said __PUNCT__ for more year than i care to recount __PUNCT__
go back to __NUM__ and __NUM__ in arkansa __PUNCT__ where i led an effort to try too bring more health care into rural area __PUNCT__ a problem we still have in northern new hampshir just as in eastern arkansa __PUNCT__
and of cours most memor __PUNCT__ dure the eight year as first ladi __PUNCT__
now despit the scar i carri from that __PUNCT__ i also have learn some valuabl lesson __PUNCT__
and most importantli __PUNCT__ that in order to answer ani question about what we can do better to provid healthcar for all of our citizen in a cost effect qualiti driven wai __PUNCT__ we first have to establish a consensu in america __PUNCT__
that thi is a goal we intend to achiev togeth __PUNCT__
we have to reach that consensu among provid __PUNCT__ employ __PUNCT__ employe __PUNCT__ citizen __PUNCT__ those who pai for __PUNCT__ depend upon __PUNCT__ and actual deliv healthcar servic __PUNCT__
and thi consensu ha to be strong enough to persuad decis maker in washington and to overcom entrench opposit among the forc that oppos chang for ideolog and corpor reason __PUNCT__
now the good new is that i think we ar final reach consensu __PUNCT__
i see busi __PUNCT__ labor __PUNCT__ govern and other stakehold increasingli invest in qualiti care becaus thei realiz that it not onli good for individu and famili that it also goof or our economi __PUNCT__
we begun to agre that there is an econom as well as a moral imper to reign in cost and to extend coverag to all american __PUNCT__
there a practic imper to improv qualiti __PUNCT__ to promot well and prevent ill wherev possibl __PUNCT__
and these ar the kei compon of my health care plan __PUNCT__ lower cost for everyon __PUNCT__ improv qualiti for everyon __PUNCT__ and provid coverag for everyon __PUNCT__
i list them as three interlock goal becaus i think we cannot do on without do all of them __PUNCT__
a few month ago __PUNCT__ i outlin my agenda to reduc health care cost and todai __PUNCT__ i want to talk about health care qualiti __PUNCT__
and next month __PUNCT__ i will announc my plan for univers coverag __PUNCT__
my order here is deliber __PUNCT__
in order to forg a consensu on univers health care __PUNCT__ we need to assur peopl thei get the qualiti thei expect at a price thei can afford __PUNCT__
and my recommend to control cost and ensur qualiti lai the groundwork for insur everyon __PUNCT__
now __PUNCT__ by all account __PUNCT__ we should alreadi have the highest qualiti health care in the world __PUNCT__
our doctor __PUNCT__ nurs and other health care practition ar among the best in the world __PUNCT__
thei have access to the most cut __PUNCT__ edg drug __PUNCT__ and treatment and medic technolog __PUNCT__
and we spend more monei per capita on health care __PUNCT__ almost __MONEY__ than ani countri in the world __PUNCT__
but we ar far from have the best care __PUNCT__
we rank __NUM__ in infant mortal and __NUM__ in life expect __PUNCT__
accord to the __NUM__ survei by the kaiser famili foundat and the agenc for healthcar research and qualiti __PUNCT__ __NUM__ percent of american were dissatisfi with the qualiti of our health care system __PUNCT__
accord to a rand studi __PUNCT__ adult in the unit state on averag fail to receiv about on half the medic care thei need __PUNCT__
more than on in ten patient mai receiv care that isn't recommend __PUNCT__ and mai be potenti harm __PUNCT__
and the institut of medicin estim that as mani as __NUM__ american ar kill each year by prevent medic error __PUNCT__
now in short __PUNCT__ too often and in too mai place __PUNCT__ our health care system hurt us instead of help us __PUNCT__
it hurt doctor __PUNCT__ who aren't reward for provid the best care __PUNCT__ and ar often punish for it __PUNCT__ financi at least __PUNCT__
it hurt nurs __PUNCT__ who ar ask to work longer hour care for more patient with fewer resourc __PUNCT__
and it hurt patient __PUNCT__ who ar forc to make complic medic decis without basic inform about their condit and option __PUNCT__
now i hope that we get to a point where the qualiti of our health care is not a partisan issu __PUNCT__
whether you a democrat or republican __PUNCT__ a liber or a conserv __PUNCT__ none of us want to rush our child to an emerg room onli to receiv the wrong treatment __PUNCT__
none of us want to bring our spous in for surgeri onli to see them next in the icu with a prevent infect __PUNCT__
none of us want our love on care for by nurs who ar juggl too mani patient and too mani medic with too littl support __PUNCT__
and ani of us could becom serious ill injur such that we won't have a second chanc to get the right diagnosi and treatment __PUNCT__
and when that dai come __PUNCT__ why should we settl for less than the best __PUNCT__ but that is exactli what we do right now __PUNCT__
when you bui a tv for your live room or a tire for your car __PUNCT__ or a toi for your child __PUNCT__ you want to know you get the best valu __PUNCT__ and these dai __PUNCT__ especi with toi __PUNCT__ the greatest safeti __PUNCT__
so you compar price __PUNCT__ you ask question __PUNCT__ you check the consum report and you reli on your govern to establish and enforc basic guarante of safeti and reliabl __PUNCT__
but too often __PUNCT__ with the product we care most about __PUNCT__ that can mean the differ between life and death __PUNCT__ and between billion of dollar wast and save __PUNCT__ we don't compar price or qualiti we wind up stuck with someth whether we think it best for us or not __PUNCT__
and until recent __PUNCT__ govern at all level did not us it enorm bui power to empow provid and patient to demand and deliv qualiti __PUNCT__
we plod along with a twentieth centuri health care system __PUNCT__ unabl to take full advantag of __NUM__ centuri medic advanc __PUNCT__ stuck in the same rut of fatalist think that defin our healthcar debat for more than a decad __PUNCT__
if we try to cover everyon __PUNCT__ the argument goe __PUNCT__ we lower qualiti __PUNCT__
if we try to improv qualiti __PUNCT__ we break the bank __PUNCT__
our health care problem ar too big __PUNCT__ too deep __PUNCT__ too complic __PUNCT__ the argument continu __PUNCT__ for us to solv __PUNCT__
well __PUNCT__ i reject that and i think all of you here at thi exemplari institut do as well __PUNCT__
america is not a nation that settl __PUNCT__
we don't wring our hand and make excus __PUNCT__
we roll up our sleev __PUNCT__
we invent __PUNCT__
we innov __PUNCT__
we come up with solut __PUNCT__
and that exactli what hospit and nurs home and provid across america have been do with veri littl support __PUNCT__
mani ar improv the care thei offer and lower cost __PUNCT__
take the exampl of kaiser permanent __PUNCT__
their manag came togeth with __NUM__ union repres __NUM__ healthcar worker and staff and form a labor manag partnership __PUNCT__
the partnership work to solv problem __PUNCT__ improv patient care and give everyon a seat at the tabl __PUNCT__
on exampl of their work involv a patient complaint that nurs often did their shift handov without input from the patient __PUNCT__ so union nurs work with manag to come up with a solut __PUNCT__ do the handov in the patient room __PUNCT__ where the patient could join in the convers __PUNCT__
as a result __PUNCT__ patient better understand their care __PUNCT__ nurs spend more time with patient __PUNCT__ and inform is be share more effici __PUNCT__
sinc kaiser partnership began __PUNCT__ cost have fallen __PUNCT__ workplac injuri have fallen __PUNCT__ and patient satisfact and employe retent have improv __PUNCT__
and thi is just on exampl of how __PUNCT__ across america __PUNCT__ worker and manag can improv healthcar qualiti __PUNCT__
or take the exampl of ascens health __PUNCT__ america largest non __PUNCT__ profit hospit system __PUNCT__
back in __NUM__ thei began a system __PUNCT__ wide effort to improv their qualiti of care __PUNCT__ to meet best practic and provid better treatment __PUNCT__
todai __PUNCT__ their rate of certain hospit infect is __NUM__ percent lower than the nation averag __PUNCT__
seriou patient fall ar __NUM__ percent lower __PUNCT__
rate of bedsor ar __NUM__ percent lower __PUNCT__
but in the end __PUNCT__ qualiti health care isn't just about save or statist __PUNCT__
it about someth much more fundament __PUNCT__ the relationship between physician and patient __PUNCT__ between nurs and patient __PUNCT__ between physician __PUNCT__ nurs and hospit administr __PUNCT__
that what at the heart of our qualiti __PUNCT__ how we get along with on anoth __PUNCT__ what our relationship ar __PUNCT__
the moment when someon in need seek you out __PUNCT__ thei scare and vulner __PUNCT__ thei want you to do what can get them better __PUNCT__ but too often our healthcar system stand in the wai __PUNCT__ block that relationship __PUNCT__ prevent physician and nurs from do what thei would want to do __PUNCT__
so therefor __PUNCT__ we have to chang the system __PUNCT__
well __PUNCT__ i here todai becaus i believ it time we had a health care system that live up to the hippocrat oath __PUNCT__
a system that empow doctor __PUNCT__ nurs and hospit to give the best care __PUNCT__
that empow patient to make the best decis __PUNCT__
and that ensur that payer __PUNCT__ govern and privat payer __PUNCT__ valu __PUNCT__ reward and promot the best result __PUNCT__ longer __PUNCT__ healthier live __PUNCT__ and monei save in lower and unproduct and unnecessari hospit and nurs home cost __PUNCT__
that is what my health care qualiti plan tri to do __PUNCT__
we have come to these recommend in consult with doctor __PUNCT__ nurs and other across the countri __PUNCT__
we develop a plan to rais standard __PUNCT__ support health care provid __PUNCT__ educ patient __PUNCT__ realign the reimburs system to reward qualiti __PUNCT__ recruit and retain more nurs __PUNCT__ and address the health dispar that continu to plagu our system __PUNCT__
i want to start by talk about how we ensur that our health care provid __PUNCT__ doctor __PUNCT__ nurs and other __PUNCT__ provid the best possibl care __PUNCT__
that start with provid feder support for doctor __PUNCT__ own qualiti certif standard __PUNCT__
now __PUNCT__ most doctor stai current on their own __PUNCT__ read up on the latest advanc __PUNCT__ studi the latest techniqu __PUNCT__
but chang ar come so fast these dai __PUNCT__ mani tell us thei just can't keep up __PUNCT__
some might not even realiz thei no longer us the latest protocol or the best system __PUNCT__
thi mai explain the dramat variat in cost and qualiti from state to state __PUNCT__ town to town __PUNCT__ even from hospit to hospit in the same town __PUNCT__
now some of these variat have been discov and public right here at dartmouth __PUNCT__ the studi conduct by jack weinberg and hi colleagu here have revolution how mani peopl think about qualiti of care __PUNCT__
thei found that the qualiti of care for patient with termin ill __PUNCT__ just to pick on exampl __PUNCT__ vari greatli __PUNCT__
the percentag of patient who di as hospit inpati instead of at home or in a hospic __PUNCT__ rang from __NUM__ percent to more than __NUM__ percent despit the fact that the overwhelm number of american would prefer not to die in a hospit __PUNCT__
part of the solut to these dispar can be found in doctor __PUNCT__ own voluntari mainten of certif program __PUNCT__ so call moc program __PUNCT__
thei provid lifelong learn opportun to help doctor stai up to date __PUNCT__
thei gener run by the board of the variou specialti __PUNCT__ so cardiolog run the moc for cardiologist __PUNCT__ or the pediatr run the moc for pediatrician __PUNCT__ and so on __PUNCT__
doctor who particip in certif program have better outcom __PUNCT__
heart attack patient treat by board certifi doctor were __NUM__ percent less like to die than those treat by non __PUNCT__ certifi doctor __PUNCT__
doctor who score higher on moc examin had better outcom in treat patient with diabet __PUNCT__ and thei were more like to ensur that their patient receiv mammogram __PUNCT__
so as presid __PUNCT__ i want to lend the support of the feder govern to moc process to help our doctor stai on the top of their game __PUNCT__
i will offer higher medicar reimburs rate to doctor who particip in qualifi moc program __PUNCT__
and to ensur that the moc ar suffici rigor __PUNCT__ i ask that the secretari of hh to invest __MONEY__ million to recogn and help fund the work of a public __PUNCT__ privat qualiti trust to certifi the moc __PUNCT__
thi trust will bring togeth peopl from across the health care system __PUNCT__ doctor __PUNCT__ patient __PUNCT__ nurs and other __PUNCT__ who will rigor review moc to ensur thei ar up to the highest standard __PUNCT__
if you have ani doubt about whether we need to do thi __PUNCT__ i refer you to an articl from thi week new york time indic that just __NUM__ percent of diabet ar get all of the treatment thei need __PUNCT__ often becaus their doctor ar not vers in the latest develop __PUNCT__
now __PUNCT__ imagin if instead __PUNCT__ these doctor particip in certif program that kept them up to date on nation recogn standard for diabet care __PUNCT__
the most reveal conclus in the veri long articl wa that most doctor were vigil about blood sugar __PUNCT__ but not about blood pressur and cholesterol monitor __PUNCT__
think of how mani more live could be save and how much more monei could be save if thei were __PUNCT__
i also support doctor by creat a best care practic institut __PUNCT__ a public __PUNCT__ privat partnership to fund compar effect research and dissemin it across the countri __PUNCT__
right now so much of the inform on which drug __PUNCT__ devic __PUNCT__ surgeri and treatment work best __PUNCT__ either isn't research __PUNCT__ it isn't compar __PUNCT__ it isn't publish __PUNCT__ and it isn't circul __PUNCT__
it take year for an agre upon treatment that a medic center like thi on know is the best practic to be dissemin across our countri __PUNCT__
so thi best practic institut will serv as a central nation clearinghous so no matter where you ar __PUNCT__ you and your doctor can access inform on what the best treatment should be __PUNCT__
in addit to help doctor provid the best care __PUNCT__ i plan to final implement medic malpractic reform that work for doctor and patient alik __PUNCT__
mani of the physician that i meet sai that high malpractic premium forc them to alter their practic __PUNCT__ and even consid leav the profess altogeth __PUNCT__
i also heard first hand from famili who experienc seriou medic error and have troubl get the relief that thei deserv __PUNCT__
the current polit stalem on thi issu leav both patient and physician in the lurch __PUNCT__
earlier befor i came in i wa speak to the head of anesthesiolog and i realli give the anesthesiologist a lot of credit becaus for the last ten year thei have move toward standard of practic that have not onli help patient but dramat lower malpractic premium and i believ there a lot we can do within the specialti __PUNCT__ follow the exampl of anesthesiolog __PUNCT__ come up with new approach __PUNCT__
i offer on solut base on a success program at the univers of michigan hospit system __PUNCT__
it call the nation medic error disclosur and compens act __PUNCT__
in the congress you have to come up with acronym so you search for dai to try to name a piec of legisl with someth that if you take the first letter it spell a word __PUNCT__ so that is the medic act for those of you who were wonder __PUNCT__
it a novel approach to improv patient safeti and the qualiti of care while protect patient __PUNCT__ right __PUNCT__ reduc medic error and lower malpractic cost __PUNCT__
the bill that i have introduc base on the univers of michigan hospit system would prove liabil protect for physician who disclos medic error to patient and offer to enter into negoti for fair compens back up by their hospit and their practic __PUNCT__
at the univers of michigan __PUNCT__ these polici have alreadi result in greater patient trust and satisfact __PUNCT__ more patient be compens for injuri __PUNCT__ fewer malpractic suit __PUNCT__ significantli reduc administr cost __PUNCT__ and between on and three million dollar in litig cost save __PUNCT__
but when i talk about support provid __PUNCT__ i not just talk about doctor __PUNCT__ but about nurs as well __PUNCT__
and that the third step in my plan __PUNCT__ to immedi address our nurs shortag and to give nurs the train and educ and support that thei need to provid the care patient deserv __PUNCT__
the nurs shortag ha becom a nurs crisi __PUNCT__
and that mean it a crisi for everyon __PUNCT__ becaus nurs ar critic to deliv and improv qualiti __PUNCT__
our nurs ar truli the ey and ear __PUNCT__ and in mani wai __PUNCT__ the heart and soul __PUNCT__ of our health care system __PUNCT__
and when we got fewer nurs __PUNCT__ work longer hour __PUNCT__ serv more patient __PUNCT__ the result can be wors outcom __PUNCT__
we current face a shortfal of __NUM__ nurs __PUNCT__
if we don't take action now __PUNCT__ by the year __NUM__ the estim is that we will be short as mani as on million nurs __PUNCT__
in addit to the shortag __PUNCT__ nurs ar ag __PUNCT__
on averag a nurs is over __NUM__ in america __PUNCT__
so we need a comprehens solut __PUNCT__
accord to the american associ of colleg of nurs __PUNCT__ in __NUM__ american nurs program turn awai nearli __NUM__ qualifi bachelor and master degre applic __PUNCT__
thei just didn't have the slot __PUNCT__
so when i presid __PUNCT__ i will provid fund to nurs school to allow them to admit and train more nurs and to recruit and retain more faculti __PUNCT__
and i give first prioriti to school with a record of send graduat to serv in underserv area __PUNCT__ from rural commun __PUNCT__ to inner __PUNCT__ citi __PUNCT__ to low __PUNCT__ incom neighborhood __PUNCT__
i also work to recruit more nurs to the profess in the first place __PUNCT__ reach out to commun of color that ar tradition underrepres __PUNCT__ provid scholarship and loan forgiv so we can have a more divers __PUNCT__ cultur compet nurs workforc __PUNCT__
but we know that the problem isn't just recruit __PUNCT__ it retain nurs __PUNCT__
roughli __NUM__ percent of new nurs leav their job within the first year __PUNCT__ all too often becaus thei not get the support thei need to do their job __PUNCT__
i will address that by fund innov mentor and resid program with a proven track record of help to keep nurs in the profess __PUNCT__
program like the rn resid program that wa launch five year ago at children hospit lo angel __PUNCT__
thi __NUM__ __PUNCT__ week program provid new nurs school graduat with a comprehens clinic experi to prepar them for career in acut care environ __PUNCT__
prior to thi program __PUNCT__ turnov for new graduat dure their first year wa __NUM__ percent __PUNCT__
graduat of the rn resid program have a first __PUNCT__ year turnov rate of just __NUM__ percent __PUNCT__ and a __NUM__ month turnov rate that ha drop from __NUM__ to __NUM__ percent __PUNCT__
given that it cost roughli __MONEY__ to replac each nurs __PUNCT__ and thousand more to pai temporari nurs to fill in __PUNCT__ you can see the kind of save that children is experienc __PUNCT__
i also want to do more to empow advanc practic nurs __PUNCT__
we go to have to chang the practic __PUNCT__ act __PUNCT__ and protocol that govern what nurs can do __PUNCT__ nurs practition __PUNCT__ nurs midwiv __PUNCT__ physician assist __PUNCT__ advanc practic profession __PUNCT__
becaus it clear that we will not be abl to reach our goal for prevent care if we don't have better util of nurs __PUNCT__
we need to empow patient __PUNCT__
and that mean give them the inform thei need to make the right choic __PUNCT__
todai even the savviest __PUNCT__ best inform patient struggl to choos provid and treatment option and it is easi to feel helpless and overwhelm about these decis __PUNCT__
now some peopl will tell you the best wai to provid consum choic is to give everyon a health save account __PUNCT__ and leav them to find the least expens __PUNCT__ most effect provid on their own __PUNCT__
if thei in good health __PUNCT__ chanc ar that thei be abl to navig thi __PUNCT__
but if thei get serious ill __PUNCT__ or have an accid that is seriou __PUNCT__ well i don't think that there much hope there __PUNCT__
the idea is that we have to realli empow patient __PUNCT__ not shift cost on to them under the guis of so call __PUNCT__ consum __PUNCT__ driven __PUNCT__ care __PUNCT__
so when i talk about inform consum choic __PUNCT__ i mean no on should have to guess their wai through thi maze __PUNCT__
that why we need a comprehens __PUNCT__ patient __PUNCT__ friendli qualiti databas __PUNCT__
with the click of a mous __PUNCT__ patient should be abl to see which hospit have the best care __PUNCT__ the best specialist __PUNCT__ the lowest infect rate __PUNCT__ the most effici discharg polici __PUNCT__ the shortest emerg room wait time __PUNCT__ and more __PUNCT__
and that is exactli what you do here at dartmouth __PUNCT__ hitchcock __PUNCT__ publish comprehens public report on everyth from the qualiti of your cancer treatment and pneumonia care to your infect prevent rate __PUNCT__
i so impress by what you done here and the differ that it is make that i have team up with senat judd gregg and introduc bipartisan legisl to creat thi kind of system on a nation scale us medicar claim data to make risk __PUNCT__ adjust qualiti report publicli avail __PUNCT__
i also empow patient by make sure that the inform that thei get is understand __PUNCT__
the center for share decis make here at dartmouth hitchcock is anoth perfect exampl __PUNCT__
thi center approach medic decis as collabor between patient and doctor __PUNCT__
doctor take the time to talk with patient __PUNCT__ discuss their concern and their goal __PUNCT__ and then help them reach the outcom thei desir __PUNCT__
and onc again the result speak for themselv __PUNCT__
__NUM__ percent of patient report thei understood their treatment choic __PUNCT__
__NUM__ percent said thei realiz which treatment risk and benefit matter most to them as thei made their decis __PUNCT__
we cannot do thi howev if we don't invest in electron medic record __PUNCT__
i alreadi propos thi as legisl __PUNCT__ a bipartisan piec of legisl that i have work on for four and a half year __PUNCT__ pass the senat last year __PUNCT__ it di in the hous __PUNCT__
but we back with bipartisan legisl again __PUNCT__
it is essenti that we begin to do thi __PUNCT__
institut like thi have electron medic record as do other of our medic center and fine hospit around the countri but we not creat a seamless system __PUNCT__
we not creat on where if you a patient here and you visit famili in florida or if you on a busi trip to la __PUNCT__ your record can be easili transmit __PUNCT__
and while __URL__ know exactli which book you bought and what music you like __PUNCT__ an emerg room doctor mai have no wai of know what medic you take __PUNCT__ what you allerg to __PUNCT__ or even what your blood type is __PUNCT__
electron medic record will chang that __PUNCT__
thei ensur that patient can have secur __PUNCT__ confidenti access to their medic histori wherev and whenev thei need it __PUNCT__
thi will save __PUNCT__ accord to a rand studi __PUNCT__ approxim __NUM__ billion dollar a year __PUNCT__
and it will also save live __PUNCT__
the va is a great exampl of a healthcar system that ha dramat improv the qualiti of patient care __PUNCT__
the american consum satisfact index survei show that va patient were significantli more satisfi with both inpati and outpati care than patient in the privat medic system __PUNCT__
the new england journal of medicin found that va healthcar rank higher than medicar in __NUM__ out of __NUM__ measur of qualiti and the va system achiev better rate of qualiti care for diabet than commerci manag care organ __PUNCT__
now what made thi success possibl __PUNCT__ well __PUNCT__ in part the us of inform technolog __PUNCT__
dure the clinton administr __PUNCT__ a transit to a paperless system wa acceler and todai the va maintain electron health record in __NUM__ facil for over __NUM__ million veteran __PUNCT__
and thi enabl someon to go from va hospit to va hospit and have that record be seamlessli deliv wherev it is need __PUNCT__
the va medic record system support the us of advanc technolog includ mobil devic __PUNCT__ wireless interfac __PUNCT__ and a barcod medic administr system in which patient ar given a bar __PUNCT__ code id tag __PUNCT__
nurs scan thi tag when provid medic allow them to confirm that the right person receiv the right medicin at the right time __PUNCT__
so the va is do it __PUNCT__ there no reason we can't do it across our healthcar system __PUNCT__ and through my coverag recommend which i will be make next month __PUNCT__ i want to come up with idea to incent patient and potenti patient which includ all of us to make better decis about our own health __PUNCT__
inform alon about behavior like smoke or obes doe not automat result in chang __PUNCT__
we need both a renew public health effort that i think should be lead by the presid __PUNCT__ stress better health outcom and financi benefit to motiv such chang through the wai we pai for public and privat insur __PUNCT__
i want to emphas that when i talk about empow patient __PUNCT__ i mean all patient __PUNCT__ from all background and all walk of life __PUNCT__
we ar far from that goal now __PUNCT__
our health care system unfortun is still plagu with racial __PUNCT__ ethnic __PUNCT__ socioeconom and gender dispar at everi level __PUNCT__
and my goal is to elimin those dispar onc and for all __PUNCT__
right now __PUNCT__ african american infant mortal rate ar more than doubl those for white __PUNCT__
more than on __PUNCT__ fifth of american indian do not have a reliabl sourc of health care __PUNCT__ as compar to __NUM__ percent of white __PUNCT__
asian __PUNCT__ american ar less like to receiv critic screen test like mammogram and pap smear __PUNCT__
hispan live with diabet ar almost __NUM__ percent less like to receiv recommend diabet treatment __PUNCT__
and women ar more like than men to be hospit for high blood pressur __PUNCT__ a manag chronic condit __PUNCT__
minor popul aren't just sicker __PUNCT__ thei also get lower __PUNCT__ qualiti care __PUNCT__
accord to the annual nation healthcar dispar report releas by hh __PUNCT__ african american and hispan receiv wors care than white on more than __NUM__ percent of the criteria us to measur qualiti __PUNCT__
thi is simpli unaccept in our countri __PUNCT__
the qualiti of your care should have noth to do with your ethnic __PUNCT__ skin color __PUNCT__ or gender __PUNCT__
and when i presid __PUNCT__ i will see to it that it doesn't __PUNCT__
i will start by direct the depart of health and human servic to collect detail __PUNCT__ up __PUNCT__ to __PUNCT__ date inform on healthcar dispar __PUNCT__ so we actual can know the full extent of the __PUNCT__
i also invest in develop cultur compet health care for minor popul __PUNCT__
that mean ensur health care provid have access to the languag skill thei need to commun with their patient __PUNCT__ and that patient inform is appropri translat into the mani languag that a hospit often ha to deal with __PUNCT__
final __PUNCT__ i want to discuss the role of payer __PUNCT__ insur compani and state and feder govern __PUNCT__ in provid qualiti health care __PUNCT__
i want to start with our reimburs system __PUNCT__
we have to complet re __PUNCT__ haul thi system __PUNCT__
we need a system that actual encourag __PUNCT__ instead of discourag __PUNCT__ qualiti care __PUNCT__
right now __PUNCT__ the incent in our reimburs system ar upsid __PUNCT__ down and backward __PUNCT__
thei often punish doctor ar try to do the right thing __PUNCT__ like spend time with their patient __PUNCT__ try to prevent __PUNCT__ not just treat ill __PUNCT__
do what best for patient is sometim bad for busi __PUNCT__
hospit ar paid for each episod of care __PUNCT__ each hospit __PUNCT__
doctor ar paid for each offic visit __PUNCT__ each procedur __PUNCT__
peopl aren't paid to coordin patient __PUNCT__ treatment to ensur thei get the best qualiti care __PUNCT__
so let sai you ar a diabet with high blood pressur __PUNCT__
your doctor won't be reimburs for hire a nutritionist to track your weight and help you understand what you can and can't eat __PUNCT__
your hospit won't be reimburs for hire a nurs assist to ensur you have regular appoint to get your feet and ey check __PUNCT__
or to make sure your blood pressur doctor and your diabet doctor commun with each other about your care __PUNCT__
and healthcar provid who wish to work in team to coordin servic and treat patient holist receiv lower reimburs than if thei all work separ __PUNCT__
so we wind up treat patient like walk collect of symptom and diseas __PUNCT__ each to be treat discret __PUNCT__
but that is not how ill work __PUNCT__ that not how the bodi or the mind work __PUNCT__
for exampl __PUNCT__ if you ar a diabet with high blood pressur __PUNCT__ your high blood pressur obvious affect your diabet __PUNCT__ and vice versa __PUNCT__
so there incred valu to coordin care and in have doctor __PUNCT__ nurs __PUNCT__ social worker __PUNCT__ nutritionist and other profession work togeth as a team __PUNCT__
that exactli how it done at the mayo clinic __PUNCT__ on of the most respect health care institut in america __PUNCT__ actual probabl in the world __PUNCT__
under their integr healthcar system __PUNCT__ primari care physician work togeth with specialist to develop a comprehens approach to treat each patient __PUNCT__
the result is better care __PUNCT__ lower cost __PUNCT__ and fewer hospit and doctor visit __PUNCT__
the result is better care __PUNCT__ lower cost __PUNCT__ and fewer hospit and doctor visit __PUNCT__
in fact __PUNCT__ if hospit and doctor visit across america mirror the number at mayo __PUNCT__ for certain condit __PUNCT__ inpati medicar spend would decreas __NUM__ percent __PUNCT__ medicar cost for doctor visit would decreas __NUM__ percent __PUNCT__
that billion of dollar in save __PUNCT__
but at the same time physician salari ar abov the nation averag __PUNCT__
so when i presid __PUNCT__ i support feder reimburs for precis thi kind of team approach to medicin __PUNCT__
we know it save monei __PUNCT__ and save live __PUNCT__
i also ensur that the feder reimburs system reward care base on how effect it is __PUNCT__
todai __PUNCT__ we often do just the opposit __PUNCT__
in a pennsylvania govern survei of the state __NUM__ hospit perform heart bypass surgeri __PUNCT__ the best __PUNCT__ paid hospit receiv nearli __MONEY__ on averag for the oper __PUNCT__ while the least __PUNCT__ paid got less than __MONEY__
but at both hospit __PUNCT__ patient had compar length of stai and death rate __PUNCT__
and among the __NUM__ hospit serv metropolitan philadelphia __PUNCT__ two of the highest paid actual had higher __PUNCT__ than __PUNCT__ expect death rate __PUNCT__
now __PUNCT__ we know we have to adjust for risk __PUNCT__ and we know that veri often the most difficult case end up at the hospit that have the greatest capac __PUNCT__
but i think we could do a better job in actual figur out what we should be pai for __PUNCT__ work that ha also been pioneer here at dartmouth __PUNCT__ hitchcock __PUNCT__
with the right incent __PUNCT__ we can make a differ __PUNCT__
take the exampl of the marshfield clinic __PUNCT__ in wisconsin __PUNCT__ where doctor ar paid base on the qualiti of care thei provid for common diseas like diabet and heart diseas __PUNCT__
thei could earn up to __NUM__ percent of the medicar save that result from their good treatment __PUNCT__
preliminari result reveal a __NUM__ percent increas in electron document foot exam for diabet __PUNCT__ and a __NUM__ percent decreas in hospit __PUNCT__
anoth excel exampl of incentiv good care with smart reimburs polici is the bush administr recent decis to refus medicar payment for prevent infect __PUNCT__ injuri and error sustain dure hospit stai __PUNCT__
a spong accident left insid a patient dure surgeri __PUNCT__ a broken arm sustain when a patient is improperli handl __PUNCT__
thei known as __PUNCT__ never event __PUNCT__ becaus thei never should have happen __PUNCT__
it not often that i offer prais for the bush administr __PUNCT__ but it is well deserv for thi decis __PUNCT__
now michigan ha had great success with systemat effort to reduc infect rate in intens care unit __PUNCT__
hospit in that state have reduc blood stream infect relat to cathet __PUNCT__ as report in the new england journal of medicin __PUNCT__
the hospit did not us expens new technolog __PUNCT__ but follow well __PUNCT__ establish infect control practic __PUNCT__ like cover doctor and patient with steril gown and sheet when cathet were insert __PUNCT__
so __PUNCT__ as presid __PUNCT__ i won't just sustain these good polici at the feder and the state level __PUNCT__ i take it on step further __PUNCT__
i insist that ani insur compani wish to provid coverag through the feder employe health benefit program __PUNCT__ which is all of them __PUNCT__ ha to also refus to cover these cost __PUNCT__
and i encourag privat plan to follow suit __PUNCT__
i believ we could not onli save billion of dollar but thousand of live over time __PUNCT__
final __PUNCT__ ensur that our reimburs system reward qualiti care also mean end insur compani discrimin against peopl with pre __PUNCT__ exist condit __PUNCT__
right now __PUNCT__ insur compani have free reign to cherri pick the healthiest patient and shut out everyon who seem like a __PUNCT__ bad risk __PUNCT__
in fact __PUNCT__ thei spend __MONEY__ billion a year on elabor underwrit calcul and scheme to figur out how not to cover peopl or that not to pai you for what you do onc you deliv the servic __PUNCT__
as presid __PUNCT__ i put an end to that __PUNCT__
i believ we should examin the patchwork natur of regul of the insur system __PUNCT__
and i believ we have to end insur discrimin __PUNCT__
now __PUNCT__ will all of thi be easi __PUNCT__ we just elect a new presid __PUNCT__ will it just happen __PUNCT__ of cours not __PUNCT__
but let rememb __PUNCT__ we gather todai at the school that introduc the stethoscop to the american medic school curriculum __PUNCT__ took the first clinic x __PUNCT__ rai __PUNCT__ establish the first icu __PUNCT__
the institut that ha alwai been push the boundari __PUNCT__ and look toward that next horizon __PUNCT__
oliv wendel holm __PUNCT__ who serv as a professor in thi school back in the __NUM__ centuri __PUNCT__ put it best when he said __PUNCT__ i find the great thing in thi world is not so much where we stand __PUNCT__ as in what direct we ar move __PUNCT__
we mai have a long road ahead of us __PUNCT__ but i believ we final move in the right direct __PUNCT__
that we can empow patient to make the right decis for themselv __PUNCT__
we can empow doctor and nurs to deliv the best care that thei want to __PUNCT__ and ar often prevent from do so __PUNCT__
we can have the highest qualiti health care system in the world and we can do it in a cost __PUNCT__ effect manner __PUNCT__
that the direct that i head in __PUNCT__
and i proud to be at thi institut __PUNCT__ which ha pioneer so mani of the chang that benefit us todai __PUNCT__ and i hope that you all join me on thi journei to better qualiti healthcar __PUNCT__
thank you all veri much __PUNCT__
